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. 2023 Jan;16(1):121-128.
doi: 10.25122/jml-2022-0227.

Main factors determining the use of free MS-TRAM and DIEP flaps and comparing the results of breast reconstruction

Ivan Ivanovich Smolanka  1 , Sergiy Petrovich Galych  2 , Oleksii Volodimirovich Movchan  1 , Irina Yuriivna Bagmut  3 , Michael Ivanovich Sheremet  4 , Igor Leonidovich Kolisnyk  3 , Oleksandr Vasyliovych Bagmut  5 , Andriy Oleksandrovich Lyashenko  1 , Irina Viktorivna Dosenko  1 , Oksana Mykolaivna Ivankova  1 , Vitaliy Vasilyevich Maksymyuk  4 , Volodimir Volodimirovich Tarabanchuk  4
Affiliations

Main factors determining the use of free MS-TRAM and DIEP flaps and comparing the results of breast reconstruction

Ivan Ivanovich Smolanka et al. J Med Life. 2023 Jan.

Abstract

This study aimed to compare the results of free MS-TRAM and DIEP-flap based on the volume of the transplant and the unique characteristics of blood flow in the tissues. The study included 83 patients, 42 in the MS-TRAM-flap reconstruction group and 41 in the DIEP-flap breast reconstruction group. In the MS-TRAM-flap group, 35 patients received delayed reconstruction, and 7 received one-stage breast reconstruction, including one case of bilateral transplantation. In the DIEP-flap group, 5 patients received one-stage reconstruction, and 36 received delayed reconstruction. Complications associated with the flap tissue were observed in 7 (16.67%) in the MS-TRAM-flap group and 8 (19.51%) cases in the DIEP-flap group. The total level of fat necrosis in MS-TRAM-flap was 7.14% (p=0.033), and in DIEP-flap, it was 9.75% (p=0.039) (2 patients had a substantial amount of fat necrosis, while 2 patients had a modest amount of focal fat necrosis). The number and diameter of perforators (including veins), as well as the transplant volume, are the primary determinants of whether to use a DIEP- or MS-TRAM-flap. DIEP-flap is preferred if there are 1-2 large artery perforators (≥1 mm) and tissue volume of 700-800 grams, while MS-TRAM-flap is used when the tissue volume is significant (>2/3 of standard TRAM-flap).

Keywords: DIEP-flap transplantations; MS-TRAM; autologous breast reconstruction; fat necrosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preoperational diagnostics of location and parameters of major perforating vessels: A – ultrasonic duplex scanning; B – fluoptics fluobeam; C – computer tomography with angiography.
Figure 2
Figure 2
MS-TRAM-flap: A – flap harvesting on medial row of perforating arteries; B – tissue complex on two perforating arteries ready for transplantation.
Figure 3
Figure 3
DIEP-flap: A –flap harvesting with one dominant perforating artery; B – tissue complex ready for transplantation.
Figure 4
Figure 4
MS-TRAM-flap breast reconstruction complications compared to a group of DIEP-flap breast reconstruction complications.
Figure 5
Figure 5
MS-TRAM-flap breast reconstruction: A – the patient before operation; B –the delayed result in 1 year.
Figure 6
Figure 6
DIEP-flap breast reconstruction: A – the patient before the reconstruction; B –the delayed result in 2 years.
See this image and copyright information in PMC

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